Driven to Distraction: Recognizing and Coping with Attention Deficit Disorder

by Edward M. Hallowell

The “morbidity” of untreated ADD is profound. Twenty-five percent of the prison population has undiagnosed ADD. Most of the kids in the juvenile justice system have untreated ADD. Traffic accidents are eight times more common than in the general population. If you have ADD, you are 40 percent more likely to get divorced than if you don’t, and 30 percent more likely to be unemployed. Estimates run as high as 40 percent of the addicted population having ADD, and a significant proportion of the eating-disordered population.

ADD is a neurological syndrome whose classic defining triad of symptoms include impulsivity, distractibility, and hyperactivity or excess energy.

He got good grades even though he never really studied. “I thought school was like playtime,” he said. But with high school, things got tougher. His innate intelligence couldn’t carry him so easily anymore, and he began to fall behind.

Often people with ADD self-medicate with alcohol or marijuana or cocaine. Cocaine, particularly, is similar to one of the medications used in the pharmacological treatment of ADD.

many people, particularly adults, the symptoms of ADD are masked by more obvious problems, such as depression or gambling or drinking, and the underlying ADD is never detected.

There is something in the most inhumane part of human nature that enjoys hurting smaller and weaker beings, particularly if they annoy us or make demands on us.

But is this part of ADD, this rage reaction, as you call it?” “Yes,” I said. “It’s part of the impulsivity. If you think of ADD as a basic problem with inhibition, it helps explain how ADD people get angry quicker. They don’t inhibit their impulses as well as other people. They lack the little pause between impulse and action that allows most people to be able to stop and think.

Due to repeated failures, misunderstandings, mislabelings, and all manner of other emotional mishaps, children with ADD usually develop problems with their self-image and self-esteem.

“The hardest thing about it all was getting teased so much. I was so reactive. All my emotions were on the surface. Someone would make a face at me, and I’d stick my tongue out right back. Someone would whisper something about me, and I’d jump on their back. Also, I cried really easily. Someone would hurt my feelings, and boohoo, the tears would come.

In many ways the most dangerous aspect of undiagnosed and untreated ADD is the assault to self-esteem that usually occurs.

the best way to fall out of love with something is to write a Ph.D. thesis about it.

Maria’s energy and openness and her story so far were all typical of ADD, as was her tendency to get sidetracked, both in her life and in her conversation

“You graduated from high school?” “Barely, but I did. Then in college I did really well. Can you imagine that?

While about 85 percent of adults will benefit from one of the several medications that are used for ADD, about 15 percent do not, for one reason or another. Some people have side effects to the medication they cannot tolerate. Some people simply find they do not like the way it makes them feel. Some people do not want to try medication at all. And for some people, like Maria, the medication just does not do anything.

she worked best in short spurts; that exercise helped her focus; that she benefited from lists, reminders, schedules, and rituals; that large, seemingly overwhelming tasks could actually get done if she broke them down into a series of small, manageable tasks; that she needed frequent feedback and encouragement; that it helped her to have someone, in this instance me, act as a kind of coach, keeping her on track.

insight is one of the most powerfully transforming factors in working with people with ADD.

She had been keeping it alive, as many people with ADD do, as an organizing principle in her life, something that although it regularly and predictably emanated pain and anxiety, still provided an axis around which she could organize.

that’s really good news that it’s complicated, and that we know that it’s complicated. Not so long ago we seemed to think all this was very simple. You were either smart or you were stupid. Oh, we had some ultra categories like genius and moron, but it was all based on a really simpleminded notion of intelligence. Smart versus stupid. And that was the basic ball game.

The key is to make the diagnosis early before these kids start getting stuck in school with all kinds of pejorative labels. With some help, they can really blossom.”

Everyone made it very clear what a failure and disappointment they believed i was

They are not just the tuned-out of this world; they are also tuned in, often to the fresh and the new.

we should be wise enough not to force them into a mold they’ll never fit.

it is of great importance that the diagnosis be made as early as possible so as to minimize the damage to self-esteem that usually occurs when these children are misunderstood and labeled lazy or defiant or odd or bad. The life of a child, and his or her family, with undiagnosed ADD is a life full of unnecessary struggle, accusation, guilt, recrimination, underachievement, and sadness.

Although it can’t be proved he had it, Mozart would be a good example of a person with ADD: impatient, impulsive, distractible, energetic, emotionally needy, creative, innovative, irreverent, and a maverick.

At age six Max entered the first grade at Meadow Glen, a coed private school. Things went all right at first, but then one day, as the kids were on the floor doing projects in pairs, Max suddenly took his jar of paint, smashed it on the floor, kicked the project he and his partner were making across the room, and started punching himself in the face. His teacher took him outside to calm down while the co-teacher stayed with the other children. “What happened in there?” his teacher asked Max. “Everything I make breaks,” he said, tears beading down his cheeks. “That’s not true,” his teacher said. “Your project was looking very good.” “It was not,” Max said. “It sucked.” “Max, you know we can’t talk like that here.” “I know,” Max said sadly. “I need more discipline and better standards.”

Heartbreaking truth hits close to home

He was also an excellent wrestler. He was especially good at the move at the start of a period when you explode out of your opponent’s grasp.

He also loved the agony of getting down to the proper weight for a meet. “I hate it, of course,” he would say, “but I also love it. It focuses my mind on one thing, one goal.”

Primary symptoms are the symptoms of the syndrome itself: distractibility, impulsivity, restlessness, and so forth. The secondary symptoms, and the ones that are most difficult to treat, are the symptoms that develop in the wake of the primary syndrome not being recognized: low self-esteem, depression, boredom and frustration with school, fear of learning new things, impaired peer relations, sometimes drug or alcohol abuse, stealing, or even violent behavior due to mounting frustration. The longer the diagnosis of ADD is delayed, the greater the secondary problems may become.

The picture of a young child who starts out well and then gradually sees his school performance tail off while teachers grow increasingly moralistic in their explanations should always suggest the possibility of ADD.

Adults with ADD associate so much anxiety with beginning a task, due to their fears that they won’t do it right, that they put it off, and off, which, of course, only adds to the anxiety around the task.

Tendency to say what comes to mind without necessarily considering the timing or appropriateness of the remark. Like the child with ADD in the classroom, the adult with ADD gets carried away in enthusiasm. An idea comes and it must be spoken—tact or guile yielding to childlike exuberance.

the person with ADD seldom feels bored. This is because the millisecond he senses boredom, he swings into action and finds something new; he changes the channel.

Easy distractibility, trouble focusing attention, tendency to tune out or drift away in the middle of a page or a conversation, often coupled with an ability to hyperfocus at times. The hallmark symptom of ADD. The “tuning out” is quite involuntary. It happens when the person isn’t looking, so to speak, and the next thing you know, he or she isn’t there. The often extraordinary ability to hyperfocus is also usually present, emphasizing the fact that this is a syndrome not of attention deficit but of attention inconsistency.

Sense of insecurity. Many adults with ADD feel chronically insecure, no matter how stable their life situation may be. They often feel as if their world could collapse around them.

Tendency toward addictive behavior. The addiction may be to a substance such as alcohol or cocaine, or to an activity, such as gambling, or shopping, or eating, or overwork.

people with ADD love big cities, all big cities but particularly New York, Las Vegas, and, especially, Los Angeles. ADD might as well have been invented in Los Angeles.

These are a few of the areas in which mild ADD may interfere with an adult’s life: underachievement; reading one’s interpersonal world accurately; getting started on a creative project, or finishing it; staying with emotions long enough to work them out; getting organized; getting rid of perseverative, negative thinking; slowing down; finding the time to do what one has always wanted to do; or getting a handle on certain compulsive types of behavior.

What’s it made of? How did it get there?” “It’s a feeling,” she said. “I don’t know how to put it, exactly. It’s a feeling that my world could collapse. Just fall down all around me. Sort of like the cartoon character who’s run out over the cliff and his legs are still pumping, but he’s only standing on air and he’s about to fall a long, long way down. I don’t know how I’ve done as much as I have, and I don’t know how long I can keep it up. I ascribe my success to the grace of God, but I’m still left with this feeling that it could all be taken away.”

Most of the problems in the marriage, at least as initially expressed, centered around Douglas. He had bothersome mood swings. He drank a lot, perhaps a bottle of wine a day.

Douglas wrote me a letter, which I excerpt here. “A theory of behavior,” he began, is only a good metaphor as long as it allows you to explain a whole raft of activities as stemming from the theory. I have to tell you that your description of me as “classic” ADD has been a particularly useful metaphor for me. In fact, coming upon it has provided me with one of the most singular experiences of my entire life, because all of a sudden there are an enormous (on the order of 1,000+ instances) number of moments in my life which make sense to me now, and didn’t before, as a consequence of your providing me with this metaphor.

Even now I have dreams which involve finding myself in prep school, and all of a sudden realizing I hadn’t graduated because I had blown all those courses so badly.

I have these dreams too!

I always feel as if describing how I feel and think about myself is too complicated; it’s as if I can hear the whole conversation in advance and I know all of the twists and turns it will take before they happen, so why bother? The effort just isn’t worth it.

Yes! So I distance myself until it passes

I turned to Melanie and said that I had to leave. I didn’t just want to leave; I had to leave. I couldn’t really explain to her or to myself why I had to leave, but I just knew I couldn’t stay there anymore.

Me in PA after the fight with my father

The tension of constructing an explanation, from A to B to C to D, apparently so simple a task, irritates many people with ADD. While they can hold the information in mind, they do not have the patience to sequentially put it out. That is too tedious. They would like to dump the information in a heap on the floor all at once and have it be comprehended instantly. Otherwise, as Douglas says, it’s just not worth the effort. It’s too boring.

While we all need external structure in our lives—some degree of predictability, routine, organization—those with ADD need it much more than most people. They need external structure so much because they so lack internal structure. They carry with them a frightening sense that their world might cave in at any moment. They often feel on the brink of disaster, as if they were juggling a few more balls than they’re able to. Their inner world begs for reassurance, for signposts and guidelines.

when a person habitually has trouble following through on plans on a minute-to-minute, even second-to-second, basis. This is not due to procrastination per se as much as it is due to the busyness of the moment interrupting or interfering with one’s memory circuits.

Got 730 on the verbal college boards but couldn’t get my papers in on time so got C’s in English.

Handwriting: sometimes I write things I don’t mean to; skip letters or form them wrong.

Easily hurt and rejected.

Sarah needed to address her issues of insecurity, her feelings about the cruel treatment she received from her father, and her sense of being different. In addressing those issues, she would do best by also understanding how ADD was complicating the picture.

unable to listen to a telephone conversation even when he wanted to, tangle himself up with patterns of procrastination and overcommitment, and find himself getting angry and irascible without provocation.